TimberRidge Challenge Course Request Form

2. 
3. 
5. Full Name*
6. Email
7. Phone Number
9. Create An Online Account
   Create an Online Account Here

   Please click on the registration link above to create an online account with your personal information. This creates a personal account for you with JCPRD and will be linked to the Organization account I create with the information you provided in this form. If you already have a personal account with JCPRD, please verify your address information in our new system is correct. By creating a personal account, I can link you as an online administrator for the organization to view their account online. DO NOT create an account for yourself and the organization..
13. Organization Name*
    Please put N/A if it doesn't apply
15. Organization Address*
16. Organization City*
17. Organization State*
18. Organization Zip Code*
20. Organization Phone Number*
    Please enter phone number in format shown.
21. Are you a School?

    1. Yes
    2. No
22. What grade are your students?
24. Date Requesting Challenge Course Program*
    Date Requesting Challenge Course Program
    Please fill in the preferred date for a challenge course program.
25. Number of People in Group*
    Groups over 100 people will need to book on a Tuesday, Wednesday or Thursday.
26. What is the age of participants?*
27. Type of Challenge Course Program Requesting*

    1. Low Challenge Course Program (1/2 Day)
    2. Low Challenge Course Program (Full Day)
    3. Low & High Challenge Course Program (Full Day)
    4. Amazing Challenge Program (1/2 day)
    5. 2 day program - Low Challenge Course/Activity Day

    Low programs are ground level to 12 ft in the air and High programs are ground level to 40 ft in the air.
29. How did you hear about our challenge course? *

    1. TimberRidge Website
    2. Johnson County Park and Recreation Website
    3. Friend or Family Referral
    4. Facebook - TImberRidge Page
    5. Attended an event at TimberRidge
    6. Child attended a field trip or summer camp program
31. Notes:
    Add any additional information about your group here. Please note any questions not addressed in the form here.
33. Staff Responding to Email
34. Date Contract Sent
    Date Contract Sent
35. Date Payment Made
    Date Payment Made

    Date Payment Made
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field